Virginia Regulatory Town Hall
Agency
Department of Medical Assistance Services
 
Board
Board of Medical Assistance Services
 
Guidance Document Change: Federally Qualified Health Center (FQHC) Change in Scope Policy
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12/16/24  12:39 pm
Commenter: Tonya Adkins, MD- HealthWorks for Northern Virginia

FQHC Change in Scope process
 

As a practicing OB/GYN and CEO for a Federally Qualified Health Center, I have personally witnessed the demand for expanded services to meet the needs of the Medicaid beneficiaries.  More staff have been added to address the increasing needs of health center patients including psychiatric issues, social determinants of health and substance use disorders.  In addition, Virginia FQHCs answered the call and provided extensive support of  the COVID response including COVID testing and vaccination in their communities.  But it has not come without cost.  Many of the supporting positions are not billable services but are critical to navigating the health system for Medicaid beneficiaries.  The escalating cost of supplies and salaries for the professionals who care for the Medicaid population has not been matched by the reimbursement for these services.  The FQHCs are dedicated to preventative and primary care for the VA Medicaid population and reimbursement needs to reflect this.  Therefore, I support these bills to ensure FQHCs can continue to provide  quality healthcare  service for our Medicaid patients.

  • 12VAC30-80-25:B.1-Reimbursement for federally qualified health centers (FQHCs) and rural health clinics (RHCs): Beginning October 1, 2001, and for each fiscal year thereafter, each FQHC/RHC shall be entitled to the payment amount (on a per-visit basis) to which the center or clinic was entitled under BIPA of 2000 in the previous fiscal year, adjusted by the percentage change in the Medicare Economic Index (MEI) for primary care services, and adjusted to take into account any increase or decrease in the scope of services furnished by the FQHC/RHC during its fiscal year.
     
  • Budget Bill - Item 288 WWWW: DMAS shall implement a process no later than January 1, 2025, for FQHCs to notify the department of any changes in the scope of services offered by an FQHC, pursuant to Section 1902(bb)(3) of 42 U.S.C. 1396a. The department is authorized to reimburse FQHCs for unreimbursed costs, as allowed by the applicable federal law, prior to an initial request for a change in scope under the new process. After more than 20 years of waiting and in compliance with Item 288 WWWW, HealthWorks for Northern Virginia, respectfully requests the implementation of this policy, along with the new PPS rate, effective January 1, 2025. We also request reimbursement for any unreimbursed costs incurred prior to the submission in accordance with applicable federal law.
CommentID: 228990